非瓣膜性心房颤动脑梗死的影像学分型及相关危险因素与发病机制探讨

Analyze the Pathogenesis by the Iconography Categories and Risk Factors of Stroke of Non Valvular Atrial Fibrillation

目的分析非瓣膜性心房颤动（non valvular atrial fibrillation,NVAF）脑梗死患者的脑梗死类型及相关发病因素,以探讨脑梗死发生的可能存在的发病机制。方法对2005年9月至2007年9月在福建医科大学附属第一医院住院和门诊的心房颤动并发脑梗死患者进行回顾性分析,通过影像学资料分析NVAF和瓣膜性心房颤动（valvular atrial fibrillation,VAF）脑梗死患者的梗死类型和相关因素的联系,探讨NVAF发生脑梗死的可能机制。结果VAF和NVAF脑梗死相同的危险因素有：心功能衰竭、高纤维蛋白原血症;不同的危险因素有：前者与过快的心室率关系密切（Χ^2=7.87,P〈0.01）,后者则与高血压、颈动脉斑块、糖尿病、高脂血症的关系密切（χ^2=8.80,P=0.003;χ^2=17.75,P〈0.01;Χ^2=4.06,P〈0.05;Χ^2=6.50,P=0.01）;两者发生脑梗死的类型分布比例不同,前者以主干脑梗死为主（Χ^2=23.98,P〈0.01）,后者类型多样,包括主干脑梗死、皮层支脑梗死、分水岭脑梗死及腔隙性脑梗死,并以分水岭脑梗死多见（χ^2=15.08,P〈0.01）。结论NVAF脑梗死以分水岭脑梗死表现多见,且与高血压、高脂血症、高血糖等动脉粥样硬化危险因素相关,提示血液动力学的改变可能是其发生脑梗死的重要机制。

Objective To study the pathogenesis of cerebrovascular disorders by analyzing the categories of cerebral infarct and the related risk factors of the NVAF patients. Methods From 2005 to 2007, we investigated the patients of cerebrovascular disorders of the NVAF in the first affiliated hospital of Fujian Medical University, and analyzed the categories of cerebral infarct and their related factors of NVAF and VAF by CT and MRI of brain. Results We found the same risk factors of the stroke patients with NVAF and VAF were heart failure and hyperfibrinogenemia, and the different factors were that the VAF-related cerebrovascular disorders was closely relation with the faster ventricular rate and the NVAF -related cerebrovascular disorders was closely related to hypertension, carotid plaques, diabetes mellitus and hyperlipemia（ Χ^2=8.80, P=0.003; Χ^2=17.75, P〈0.001; Χ^2=4.06, P〈0.05; Χ^2=6.50, P=0.01）. The distribution ratio of categories of them were different, and the reason of the stroke patients of the VAF was mainly aortic embolism（ Χ^2=23.98, P〈0.001）, however, the NVAF was aortic embolism, cortical branch infarct, watershed infarct and lacunar infarct and so on, especially watershed infarct（ Χ^2= 15.08, P〈0.001）. Conclusion NVAF patients may suffer from a variety of cerebral infarctions, especially watershed infarct. In the meantime, they were closely related to the risk factors of atherosclerosis （including hypertension, hyperlipemia and hyperglycemia）. We thought that hemodynamic changes may be one of the important pathogenesis of cerebral infarct.